Zeitschrift fur Gastroenterologie最新文献

Approximately 4% of all cancer cases worldwide are caused by alcohol consumption (oropharynx, larynx, esophagus, stomach, colorectum, liver and the female breast). Various mechanisms contribute to ethanol-mediated carcinogenesis, including the action of acetaldehyde, the first metabolite of ethanol oxidation and oxidative stress primarily promoted through the induction of cytochrome P4502E1. Acetaldehyde is toxic and carcinogenic, binds to DNA and proteins, inhibits the oxidative defense- and the nuclear repair system, and prevents DNA methylation. High levels of acetaldehyde occur through increased production in the presence of a hyperactive alcohol dehydrogenase (ADH1C*1,1) or decreased degradation in the presence of low active aldehyde dehydrogenase (ALDH2*1,2). In addition, microbes of the upper alimentary tract and the colorectum effectively produce acetaldehyde from ethanol. In addition, ethanol induces cytochrome P4502E1 resulting in an enhanced ethanol metabolism and the generation of reactive oxygen species (ROS). ROS may cause lipid peroxidation (LPO) with the LPO-products 4-hydroxynonenal or malondialdehyde, which may form highly carcinogenic etheno DNA-adducts CYP2E1 is also involved in the activation of a variety of dietary and tobacco procarcinogens and in the degradation of retinoic acid. Alcohol also influences tumor promotion, such as epigenetics with a change in DNA methylation and histone modification, and affects a variety of cancer genes and signaling pathways. Preventive measures include reducing alcohol consumption, quitting smoking and keeping good oral hygiene. Alcohol consumers - especially when they smoke or belong to genetic risk groups - should be regularly checked for cancer of the upper alimentary tract, for alcohol- associated liver disease, and for breast cancer. Cessation or reduction of alcohol consumption definitively reduces cancer risk.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare in the gastrointestinal tract.We report the case of a patient in whom complete endoscopic resection of a tumorous lesion in the tubular esophagus, initially diagnosed as squamous cell carcinoma (SCC) led to the diagnosis of SCC-MiNEN, which changed the patient´s treatment course.With improvements in endoscopic techniques, we advocate resection of small malignant lesions in the gastrointestinal tract for both curative and diagnostic reasons.

The treatment of Helicobacter pylori infection, so far, focussed on empirical antibiotic regimens. Facing increasing resistance dynamics and regionally different resistance patterns, however, resistance testing respectively resistance-guided therapy appears to be more appropriate. This helds not only in order to increase the effectiveness of individual therapy, but also in the sense of antibiotic stewardship. In particular, in the context of predominantly gastroscopic diagnostics, various options for resistance testing using culture and PCR are available. Thus, the optimal resistance-oriented therapy regimens can be derived on an individual basis.

Hepatitis D virus (HDV) infection is the most severe form of viral hepatitis and has been shown to be associated with reduced quality of life. With the approval of the entry inhibitor bulevirtide, the first specific agent for HDV infection became available. Here, we report data on quality of life (QOL) before and during antiviral therapy with bulevirtide in a single center real-world cohort.We investigated QOL assessed by the Short Form 36 Health Survey (SF-36) in 25 patients undergoing antiviral treatment with bulevirtide. Surveys were completed before the beginning of antiviral therapy and up to week 152 of treatment as a long-term follow up.The study cohort included 7 women (28%) and 18 men (72%) with a median age of 46 years. Liver cirrhosis (defined as liver stiffness measurement ≥ 15.2 kPa) was present in 16 patients (64%) at the start of antiviral treatment. During the course of antiviral treatment with bulevirtide, scores for vitality, mental health and bodily pain significantly improved. The physical component score showed a minimal clinically important increase of ≥ 2.5 points in 10 patients (42%) at week 24 and in 6 patients (30% of patients with full data available) at week 48. The mental component score showed a minimal clinically important increase (≥ 2.5 points compared to baseline) in 10 patients (42%) at week 24 and in 12 patients (60%) at week 48. In the patient cohort with an improvement of physical or mental component scores at week 48, a further improvement beyond week 48 was evident in single cases but not in all patients. Importantly, changes of physical or mental component scores were not associated with virological or biochemical responses.Vitality, mental health and bodily pain improved during BLV treatment. As a sign of the good tolerability of BLV, no significant deteriorations in QOL scores were observed. Findings need to be confirmed and further evaluated in larger cohorts and longer follow-up is needed.

The demands on modern endoscopy have grown rapidly in various areas in recent decades. These include challenges for the endoscopy team due to more demanding interventional procedures, but also the rapidly changing conditions that today's working reality entails. In order to continue to meet the necessary safety and quality standards, it can help to look at similarly complex areas such as civil aviation to find inspiration for effective concepts in endoscopy.Crew Resource Management (CRM) and Threat and Error Management (TEM) are important concepts from civil aviation that currently make aviation the safest mode of transportation in the world. Elements such as communication, teamwork, situational awareness, decision-making and an open error culture can also be used in medicine. Some of these have already been successfully transferred to acute medical areas by using CRM-based training and general or specific checklists. In order to also benefit as much as possible from the findings in endoscopy, workshops tailored to the individual requirements of the respective endoscopy unit are available, in which measures can be developed in collaboration with professional CRM trainers. Examples of this would be a standardized communication guideline for endoscopic procedures, a pre-interventional safety checklist or a TEM-based dialogical team time-out. After implementation, regular evaluation and further development of the measures are essential for long-term success.Elements transferred from civil aviation have the potential to promote communication, situation-aware teamwork, structured decision-making and an open error culture in endoscopic teams and thus contribute to safe and high-quality interventions.

Endoscopic submucosal dissection (ESD) is an established technique for the resection of early neoplasia in the gastrointestinal tract (GIT). A further development of this technique is the resection under isotonic saline solution (underwater ESD or uESD), also referred to as Saline Immersion Therapeutic Endoscopy (SITE). Potential advantages include faster submucosal access and a reduced rate of intraprocedural complications, particularly submucosal bleeding. The primary objective of this retrospective, single-centre analysis was to provide the first data from Germany concerning the efficacy and safety of uESD and compare it to conventional ESD (cESD).This retrospective study analysed data from patients who underwent either uESD (n=36) or cESD (n=36). The control group (cESD) included lesions of similar location and size. Lesion selection was validated using propensity score matching. Treatment duration, complication rate, en-bloc resection rate, R0 resection rate, and recurrence rate were compared.A total of 72 ESD procedures were performed in 72 patients (36 undergoing uESD and 36 cESD). Per group, 11 procedures were performed in the esophagus, 3 in the stomach, 16 in the colon and 6 in the rectum. The median lesion size was 40 × 30 mm for uESD and 45 × 30 mm for cESD (p = 0.653). The median procedure time was similar (uESD: 77 minutes, cESD: 75 minutes, p = 0.088). The en-bloc resection rate was 100% in both groups, and the R0 resection rate was 94.4% (uESD) vs. 91.7% (cESD). The complication rate was low, with one post-ESD stricture in the uESD group (2.8%) and two post-ESD bleedings in the cESD group (5.6%) (p = 1.000). No postinterventional perforations occurred in either group.uESD is as effective and safe as cESD. Both techniques achieve high technical and clinical success rates with low complication rates. Future prospective studies should evaluate potential intraoperative advantages of uESD, such as the speed of submucosal entry and possible intraprocedural complications (e.g., bleeding, muscle injury).

Perisplenic masses or collections are rare findings on imaging examinations. The differential diagnostic spectrum is broad. We report the case of an 84-year-old man who presented to our emergency department with fatigue, unwanted weight loss, loss of appetite and abdominal pain. In B-mode ultrasound a very hypoechoic collection circularly located around the spleen was seen. A splenic hematoma or an abscess were primarily suspected. Performing contrast-enhanced ultrasound examination the perisplenic collection was surprisingly strongly contrasted in the arterial phase. An additional abdominal CT confirmed the mass in the left upper abdomen circularly around the spleen, compressing the left colic flexure and beginning to infiltrate the gastric fundus. An ultrasound-guided tissue biopsy was taken via a percutaneous intercostal approach, which resulted in the diagnosis of a low-grade epithelioid malignant peritoneal mesothelioma (MPM). MPM often presents with diffuse multifocal involvement of the peritoneal lining, however a unifocal manifestation of MPM is uncommon in general. A perisplenic mass manifestation of malignant peritoneal mesothelioma is an extremely rare occurrence. This case highlights the diagnostic challenges posed by the rare perisplenic manifestation of MPM.

The THR-β agonist resmetirom is the first treatment approved for metabolic dysfunction-associated steatohepatitis (MASH) in the US so far. It can be prescribed given MASH and F2/F3-fibrosis ("at-risk MASH").We analyzed how many patients qualify for resmetirom in a recently recruited Steatotic Liver Disease-cohort involving both tertiary and secondary care centers, the German SLD-Registry.Indication for resmetirom was assessed by three different approaches: (i) biopsy-proven MASH with F2/3 fibrosis and NAS-score ≥ 4; (ii) FibroScan-AST (FAST) score ≥ 0.67 and vibration controlled transient elastography (VCTE) < 15 kPa; (iii) US expert recommendations with VCTE 10-15 kPa and platelets ≥ 140×109/L or VCTE 8-15 kPa.1113 patients were recruited across 8 tertiary and 12 secondary care centers. NAS grading and staging were available for 180 cases (16%) with 179/180 conducted at tertiary care level. Of these, 61 (34%) qualified for resmetirom. FAST score without histologic assessment was available for 638 cases (57.3%), of which 612 (87%) were from tertiary and 26 (11%) from secondary care centers. Based on approach (ii), 41 (6%) of these individuals qualified for resmetirom compared to 117 (18.3%) using approach (iii). Combining approach (iii) with FAST ≥ 0.67 leads to 191 (30.0%) eligible patients. Using VCTE 8-15 kPa results in 182 (28.5%) eligible patients.Eligibility for resmetirom treatment depends on the available method used to identify "at-risk MASH". Availability of VCTE was highest among different levels of care.